Guideline Update Cites Value of Oral Steroids to Treat Bell Palsy

November 7, 2012

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Oral steroids can improve the likelihood of full facial recovery in people with new–onset Bell palsy, according to “Evidence–based Guideline Update: Steroids and Antivirals for Bell Palsy,” that was published electronically ahead of print on November 7, 2012, and appears in the November 27, 2012, issue of Neurology®.

“Although most cases of Bell palsy resolve without treatment, about 15 percent of those affected never fully recover muscle strength. There are now several well–designed studies that show these treatments can increase the chances of a good recovery in such cases,” said study lead author Gary Gronseth, MD, FAAN.

Antiviral therapy alone has not been shown in well–designed studies to increase the likelihood of full facial recovery. Physicians might offer antiviral drugs as an addition to oral steroid treatment, but they should inform their patients that a benefit from this drug combination has not been strongly demonstrated by well–designed studies. “Because of the possibility of modest recovery with combination treatment, people might be offered both oral steroids and antiviral medications,” said Gronseth. “However, patients should be informed that if there is an added benefit of combination therapy, it will be marginal at best.”

Not all patients are candidates for drug treatment. People with certain comorbidities—such as diabetes mellitus, morbid obesity, osteopenia, and a history of steroid intolerance—might be at risk for complications with steroid use.

The studies examined in the guideline showed treatment had an effect within a week of symptoms onset.